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Posttraumatische Arthrosen des Glenohumeralgelenks

Gelenkerhaltende Therapieoptionen

Posttraumatic arthritis of the glenohumeral joint

Joint-preserving therapy options

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Zusammenfassung

Hintergrund

Die Therapie der Omarthrose bei jüngeren Patienten mit hohem Aktivitätsniveau stellt eine Herausforderung für den orthopädischen Chirurgen dar. Die Endoprothetik erzielt in diesem Kollektiv häufig nur unbefriedigende klinische Ergebnisse bei begrenzter Standzeit der Prothese.

Fragestellung

Diese Übersichtsarbeit stellt Indikation, Technik und Ergebnisse arthroskopischer gelenkerhaltender Therapieverfahren für Patienten mit Omarthrose dar.

Methoden

Es erfolgte eine selektive Literaturrecherche unter Berücksichtigung eigener Erfahrungen.

Ergebnisse

Neben einer relevanten Schmerzreduktion sowie Verbesserung der Beweglichkeit und Patientenzufriedenheit kann durch arthroskopische Verfahren eine teils deutliche Verzögerung der Endoprothesenimplantation erreicht werden. Von besonderer Bedeutung scheint neben der débridierenden Komponente die umfassende Adressierung aller relevanten Begleitpathologien des arthrotisch veränderten Schultergelenks. Eine Weite des glenohumeralen Gelenkspalts von unter 2 mm im konventionellen Röntgenbild ist mit deutlich schlechteren Ergebnissen der arthroskopischen Versorgung vergesellschaftet.

Schlussfolgerungen

Arthroskopische Verfahren stellen insbesondere für jüngere Patienten mit hohem Aktivitätsniveau eine gute Therapieoption bei Omarthrose dar. Der Patientenauswahl und dem Konsens der präoperativen Erwartungshaltung kommt eine besondere Bedeutung zu.

Abstract

Background

The management of glenohumeral osteoarthritis in younger patients with high activity levels remains a challenge to orthopedic surgeons. The clinical results of joint replacement surgery are commonly unsatisfactory in this particular cohort with the associated problem of limited longevity of the implant.

Objectives

This paper reviews the indications, techniques and outcomes of joint-preserving arthroscopic surgery for the treatment of osteoarthritis of the shoulder.

Methods

A selective literature search was performed and personal surgical experiences are reported.

Results

Besides significant pain reduction, improved range of motion and increased patient satisfaction, arthroscopic surgery can delay the need for total shoulder arthroplasty. A comprehensive approach that addresses all concomitant pathologies of the shoulder joint is of particular importance. Recent studies have shown that a glenohumeral joint space of less than 2 mm predicts significantly poorer results with arthroscopic therapy.

Conclusion

Arthroscopic procedures are a good option to treat young, active patients with osteoarthritis of the shoulder. Patient selection and setting a consensus for appropriate preoperative expectations are of particular relevance.

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Authors and Affiliations

  1. Steadman Philippon Research Institute, 181 West Meadow Drive, Suite 1000, 81657, Vail, CO, USA

    M. Petri MD & P.J. Millett

  2. The Steadman Clinic, Vail, CO, USA

    M. Petri MD & P.J. Millett

  3. Unfallchirurgische Klinik, Medizinische Hochschule Hannover, Hannover, Deutschland

    M. Petri MD, R. Meller & C. Krettek

  4. Klinik und Poliklinik für Orthopädie, Unfallchirurgie und Plastische Chirurgie, Universitätsklinik Leipzig, Leipzig, Deutschland

    U.J. Spiegl

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Correspondence to M. Petri MD.

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Interessenkonflikt

M. Petri ist derzeit Angestellter des Steadman Philippon Research Instituts, und sein AGA-Fellowship-Programm wird von Arthrex gesponsort. P.J. Millett ist als beratender Arzt für Arthrex und Myos tätig und Aktieninhaber bei GameReady and VuMedi. Das Steadman Philippon Research Institute ist ein non-profit Forschungsinstitut und erhält Forschungsförderung von Smith & Nephew, Arthrex, Ossur und Siemens. R. Meller, U.J. Spiegl und C. Krettek geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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C. Krettek, Hannover

R. Meller, Hannover

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Petri, M., Meller, R., Spiegl, U. et al. Posttraumatische Arthrosen des Glenohumeralgelenks. Unfallchirurg 118, 586–591 (2015). https://doi.org/10.1007/s00113-015-0035-6

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  • DOI: https://doi.org/10.1007/s00113-015-0035-6

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